Public Health Consequences of the Defense of Marriage Act for Lesbian and Bisexual Women: Suicidality, Behavioral Difficulties, and Psychiatric Treatment

Abstract

In this article, we examine the associations between women’s relationship status and sexual orientation in relation to suicidality (ideations and attempts), selfperceived excessive use or difficulties controlling the use of alcohol, drugs, and sex, and self-reported psychotherapy and psychiatric medications (past and present). On the basis of our analysis of these factors, we argue that the US Defense of Marriage Act (DOMA) and the ban on same-sex marriage may have adverse health consequences for lesbians and bisexual women. Marriage is a well-known protective factor against suicidality and concomitant psychopathology (Smith et al., 1988), and DOMA deprives lesbians and bisexual women of its security. Homosexuality is no longer officially regarded as a psychopathology. Homosexuality per se was removed from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in 1973, and ego-dystonic homosexuality was eliminated in 1987. More recently, homosexuality was deleted from the International Classification of Diseases in 1992. However, recent studies (Gilman et al., 2001; Mays and Cochran, 2001) have noted higher risks of stress-related disorders, such as depression and anxiety, among nonheterosexuals than in the general population. Because homosexuality is not regarded as a psychopathology, the cause for the higher rates of stress-related disorders among gay men, lesbians, and bisexual women relative to heterosexuals may be related to sociological rather than psychological differences between the two groups. We focus on marriage because it is legally proscribed in many countries and married individuals in every age and sex group have the lowest suicide rates (Smith et al., 1988). Psychopathology is a risk factor for suicide (Desjarlais, Eisenberg, Good and Kleinman, 1995), and social theorists (Durkheim, 1966) have noted that marriage is a protective factor against suicide. There is also a clear relation between sexual orientation and suicidality (McDaniel et al., 2001).